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At the completion of this chapter, the reader will be able to:

  1. Describe the anatomy of the joints, ligaments, muscles, blood, and nerve supply that comprise the forearm, wrist, and hand.

  2. Describe the biomechanics of the forearm, wrist, and hand, including open- and close-packed positions, normal and abnormal joint barriers, and stabilizers.

  3. Describe the purpose and components of the tests and measures for the forearm, wrist, and hand.

  4. Describe the relationship between muscle imbalance and functional performance of the forearm, wrist, and hand.

  5. Perform a comprehensive examination of the forearm, wrist, and hand, including palpation of the articular and soft-tissue structures, specific passive mobility, and passive articular mobility tests, and stability tests.

  6. Outline the significance of the key findings from the tests and measures and establish a diagnosis.

  7. Summarize the various causes of the forearm, wrist, and hand dysfunction.

  8. Develop self-reliant intervention strategies based on clinical findings and established goals.

  9. Evaluate the intervention effectiveness in order to progress or modify an intervention.

  10. Plan an effective home program and instruct the patient in same.


A hand is a very personal thing. It is the interface between the patient and his or her world. It is an emblem of strength, beauty, skill, sexuality, and sensibility. When it is damaged, it becomes a symbol of vulnerability of the whole patient.

—Paul W. Brand (1914–2003)

In a sense, the shoulder, elbow, and wrist joints (Fig. 18-1) are merely mechanical devices that contribute to the usefulness of the hand.1 The correct synchronization of these biological devices, coupled with patient motivation, produces a remarkable level of dexterity and precision.


Arm, wrist, and hand joint structures. (Reproduced, with permission, from Chapter 29. Overview of the Upper Limb. In: Morton DA, Foreman K, Albertine KH. eds. The Big Picture: Gross Anatomy. New York, NY: McGraw-Hill; 2011.)

The carpus, or wrist, represents a highly complex anatomic structure, comprising a core structure of 8 bones; more than 20 radiocarpal, intercarpal, and carpometacarpal (CMC) joints; 26 named intercarpal ligaments; and 6 or more parts of the triangular fibrocartilage complex (TFCC).2 While these structures can be differentiated anatomically, they are functionally interrelated with movement in one joint having an effect on the motion of neighboring joints. This relationship extends as far as the elbow.

The hand accounts for about 90% of upper limb function.3 The thumb, which is involved in 40–50% of hand function, is the more functionally important of the digits.3 The index and middle fingers are each involved in about 20% of hand function, and are the second most important, with the ring finger being the least important. The middle finger is the strongest finger and is important for both precision and power functions.3...

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